MowOot and Trans-anal Irrigation fOr coNstipation

Inclusion Criteria:

1. Adult people (18 yo or older) of any gender

2. Attending their pre-scheduled on-site visit to the site (The Sir Alan ParksPhysiology & Pelvic Floor Biofeedback Unit | Central Middlesex Hospital) due toconstipation (Symptoms meeting the American College of Gastroenterology definitionof chronic constipation: unsatisfactory defaecation characterized by infrequentstool, difficult stool passage or both for at least previous 3 months.

3. Bothered by their constipation

4. Failed biofeedback (in absence of outlet problems)

5. In waiting list to use TAI

6. Able to undertake the treatment with the MOWOOT device or TAI themselves, or with acarer willing to do it

7. Able to understand the study requirements

8. Able to understand written and spoken English (due to questionnaire validity)

9. Able and willing to provide written informed consent to participate

Exclusion Criteria:

A subject will not be eligible for inclusion in this study if any of the following criteria apply:

Disease phenotype exclusion criteria:

• Irritable Bowel Syndrome with Diarrhoea (IBS-D) or alternating constipation anddiarrhoea (IBSmix): (not due to laxative use)

• Inflammatory Bowel Disease (IBD)

• Significant outlet problem

• Trapping rectocele

• Intra anal rectal intussusception

• External rectal prolapse

Device-related exclusion criteria:

• Abdominal perimeter ≤65cm or ≥130cm

• Unable to independently use the MOWOOT technology, unless a carer is available dailyto assist

Other medical conditions, medications and contraindications:

• Pregnancy or attempt to become pregnant in the next 6 months.

• Previous large bowel resection

• Active anorexia or bulimia

• Active abdominal cancer

• Large inguinal or umbilical hernia

• Recent abdominal scars, abdominal wounds or skin disorders that may make abdominalmassage uncomfortable

• Any condition that contraindicates abdominal massage.

• Significant abdominal pain

• Participation in another parallel interventional clinical trial or less than 2months from participation in a previous interventional clinical trial

• Planned surgery* if it might be within trial dates (* minor surgery not affectingadherence to treatment is allowed)